Hastings Center Report最新文献

This letter responds to the essay “Nothing about Us without Us in Precision Medicine: A Call to Reframe Disability Difference in Genetics and Genomics,” by Kevin Mintz, Joseph Stramondo, and Holly Tabor, in “Envisioning a More Just Genomics,” the November-December 2024 special report of the Hastings Center Report.

What is a good use of digital mental health technologies, including AI therapy chatbots (AITCs)? In my commentary on Amitabha Palmer and David Schwan's article “Digital Mental Health Tools and AI Therapy Chatbots: A Balanced Approach to Regulation,” I analyze the challenges of describing an AITC, with its simulation of human characteristics and abilities. The core challenge posed by this type of technology is the following ethical gap: AITCs simulate therapeutic conversations or even relationships but cannot fulfill ethical requirements connected with these. This poses risks for individuals seeking mental health support. My central recommendations include establishing standards for AITCs’ interaction and the degree of AITCs’ humanlikeness; refraining from promoting these chatbots as capable of forming therapeutic relationships until there is more evidence about the long-term effects of the technology and until the ethical gap is meaningfully addressed; and focusing on AITCs, not as humanlike agents, but as systems that can create conditions in which human values and values of mental health care are embedded and embodied.

This letter responds to the essay “Confronting the ‘Weaponization’ of Genetics by Racists Online and Elsewhere,” by Aaron Panofsky, Kushan Dasgupta, Nicole Iturriaga, and Bernard Koch, in “Envisioning a More Just Genomics,” the November-December 2024 special report of the Hastings Center Report.

Digital mental health tools (DMHTs) offer a potential solution to overcoming economic, cultural, and geographic barriers to the increasing demand for mental health care, but their adoption raises significant ethical, legal, and social concerns. This article identifies ethical risks related to DMHTs and, in this light, proposes three important criteria for evaluating regulatory approaches. These approaches should (a) ensure widespread access and (b) balance access with risk management while (c) acknowledging preexisting markets and digital self-medication. Our analysis of three regulatory models—the laissez-faire approach, a highly regulated approach, and the current U.S. Food and Drug Administration approach—reveals that none satisfactorily balances the promise of access with ethical risks. We therefore suggest modifications to the current FDA approach; these involve a voluntary certification program for nonprescription DMHTs, more-stringent data safety and privacy practices, easily accessible diagnostic tools, continuous monitoring, and independent audits. These modifications secure the accessibility benefits of DMHTs while mitigating risks associated with widespread use.

Digital mental health tools are increasingly used outside traditional clinical settings, creating an engagement paradigm beyond the existing regulatory scope, as noted by Amitabha Palmer and David Schwan in their article “Digital Mental Health Tools and AI Therapy Chatbots: A Balanced Approach to Regulation.” Introducing the direct-to-user concept (which concerns individuals as autonomous agents navigating self-regulation, enhancement, and meaning making), we propose a shift from paternalism and rigid standards critiqued by Palmer and Schwan toward a human-centered governance approach in which radical transparency, individual agency, and shared accountability are themselves the standards. Transparency enables informed choice through intelligible disclosure of data, validity, and incentives, which empower users to assess trade-offs based on personal goals and values. Evolving accountability frameworks, such as voluntary certification with collective liability, reinforce the scalability and ethics of this model, which can also be broadly applied to other digital health tools and cognitive-enhancement technologies. This governance framework fosters individualized, participatory ecosystems to make this new generation of tools more accessible.

This letter responds to the letter by Jan te Nijenhuis, Bryan J. Pesta, and John G. R. Fuerst in the May-June 2025 issue of the Hastings Center Report.

The ethics literature and professional guidelines call for extensive discussions prior to prescreening consent to prenatal cell-free DNA screening to, theoretically, allow patients to make decisions that match their values and goals of care. Most patients, however, actively avoid in-depth moral deliberation when consenting to prenatal screening and then receive a screen-negative result, suggesting that an information-heavy process is irrelevant for average-risk pregnancies. In addition, extensive information-based consent procedures are not feasible in many resource-limited contexts. Meanwhile, patients and families with screen-positive results frequently report minimal support following screening, resulting in long-term distress and suboptimal outcomes. We argue for a fundamental shift to an approach we call “just-in-time consent”: identifying the essential information for values-based decisions prior to screening while relocating resources and moral deliberation to when families receive screen-positive results. This model both ensures that patients and families receive support when they most need it and maintains high standards for the ethical provision of prenatal genetic screening.

Since the U.S. Supreme Court's decision in Dobbs v. Jackson Women's Health Organization, the popular media has been flooded with stories about pregnant patients experiencing obstetric complications who were denied access to necessary abortion care and suffered tragic consequences. Yet some of the lesser-told relevant stories include far subtler impacts on the patient-physician relationship. In this commentary, I reflect on interviews that my team and I conducted with general obstetrician-gynecologists in states with near-total bans on abortion. They shared their sense that abortion bans had resulted in an imaginary “third person” in the room, haunting the clinical encounter and intervening in care. I suggest that post-Dobbs abortion bans drive a wedge into the physician-patient relationship that is figuratively embodied by invoking the “third person” in the room.